Objective:To investigate the application value of photon-counting detector CT (PCD-CT) in preoperative identification of critical anatomical structures and surgical assessment in pancreatic cancer, and to compare its performance with conventional energy-integrating detector CT (EID-CT) in delineating tumor margins, vascular structures, and neural anatomy.Methods:This single-center retrospective matched case-control study included 25 patients with pathologically confirmed pancreatic ductal adenocarcinoma who underwent PCD-CT enhanced scanning and curative surgery at Peking Union Medical College Hospital between February and June 2025 (PCD-CT group). These patients were matched in a 1∶2 ratio to 50 patients who underwent EID-CT between January 2016 and December 2024 and subsequently received curative surgery (EID-CT group). Tumor boundary clarity, vascular visualization scores, and neural structure visibility were subjectively evaluated using the Likert scoring system. The assessed vessels included the celiac artery, common hepatic artery, superior mesenteric artery, splenic artery, portal vein, superior mesenteric vein, splenic vein, and pancreaticoduodenal arterial arcade. Imaging-based assessment of structural involvement was compared with intraoperative findings and pathological results to calculate diagnostic accuracy. Surgeons rated the usefulness of PCD-CT images for identifying key structures and determining resectability using a 5-point Likert scale. The Mann-Whitney U test was used for group comparisons of subjective scores, and categorical data were analyzed using the χ2 test or Fisher exact test. Results:The PCD-CT group showed significantly higher scores for tumor boundary clarity, vascular visualization, and neural structure detectability than those of the EID-CT group (all P<0.05). The accuracy of assessing superior mesenteric vein involvement was 96.0% (24/25) in the PCD-CT group and 72.0% (36/50) in the EID-CT group, with a significant difference ( χ2=6.00, P=0.014). Postoperative surgeon evaluations indicated that PCD-CT provided substantial assistance for both key structure identification [5 (5, 5)] and resectability assessment [5 (4, 5)]. Conclusion:PCD-CT demonstrates superior performance over EID-CT in preoperative delineation of tumor margins, vascular structures, and neural anatomy and in the assessment of structural involvement in pancreatic cancer. It provides valuable anatomical information to support preoperative evaluation and surgical decision-making.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Glioblastoma (GBM) is a highly aggressive primary brain tumor characterized by poor prognosis. Conventional chemo-radiotherapy demonstrates limited therapeutic efficacy and is often accompanied by significant side effects, largely due to factors such as drug resistance, radiation resistance, the presence of the blood-brain barrier (BBB), and the activation of DNA damage repair mechanisms. There is a pressing need to enhance treatment efficacy, with BRD4 identified as a promising target for increasing GBM sensitivity to therapy. Lacking small molecule inhibitors, BRD4 can be degraded using PROteolysis Targeting Chimera (PROTAC), thereby inhibiting DNA damage repair. To deliver PROTAC, SIAIS171142 (SIS) effectively, we designed a responsive nanocapsule, MPL_(SS)P@SIS, featuring GBM-targeting and GSH-responsive drug release. Modified with 1-methyl-l-tryptophan (MLT), nanocapsules facilitate targeted delivery of SIS, downregulating BRD4 and sensitizing GBM cells to radiotherapy and chemotherapy. After intravenous administration, MPL_(SS)P@SIS selectively accumulates in tumor tissue, enhancing the effects of radiotherapy and temozolomide (TMZ) by increasing DNA damage and oxidative stress. GSH activates the nanocapsules, triggering BRD4 degradation and hindering DNA repair. In mouse models, the nanosensitizer, combined with TMZ and X-ray irradiation, efficiently inhibited the growth of GBM. These findings demonstrate a novel PROTAC-based sensitization strategy targeting BRD4, offering a promising approach for effective GBM therapy.

Objective To explore the prognostic value of glycolysis-related genes in colorectal cancer (CRC) patients and formulate a novel glycolysis-related prognostic risk model. Methods Single-cell and bulk transcriptomic data of CRC patients, along with clinical information, were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Glycolysis scores for each sample were calculated using single-sample Gene Set Enrichment Analysis (ssGSEA). Kaplan-Meier survival curves were generated to analyze the relationship between glycolysis scores and overall survival. Novel glycolysis-related subgroups were defined among the cell type with the highest glycolysis scores. Gene enrichment analysis, metabolic activity assessment, and univariate Cox regression were performed to explore the biological functions and prognostic impact of these subgroups. A prognostic risk model was built and validated based on genes significantly affecting the prognosis. Gene Set Enrichment Analysis (GSEA) was conducted to explore differences in biological processes between high- and low-risk groups. Differences in immune microenvironment and drug sensitivity between these groups were assessed using R packages. Potential targeted agents for prognostic risk genes were predicted using the Enrichr database. Results Tumor tissues showed significantly higher glycolysis scores than normal tissues, which was associated with a poor prognosis in CRC patients. The highest glycolysis score was observed in epithelial cells, within which we defined eight novel glycolysis-related cell subpopulations. Specifically, the P4HA1⁺ epithelial cell subpopulation was associated with a poor prognosis. Based on signature genes of this subpopulation, a six-gene prognostic risk model was formulated. GSEA revealed significant biological differences between high- and low-risk groups. Immune microenvironment analysis demonstrated that the high-risk group had increased infiltration of macrophages and tumor-associated fibroblasts, along with evident immune exclusion and suppression, while the low-risk group exhibited higher levels of B cell and T cell infiltration. Drug sensitivity analysis indicated that high-risk patients were more sensitive to Abiraterone, while low-risk patients responded to Cisplatin. Additionally, Valproic acid was predicted as a potential targeted agent. Conclusion High glycolytic activity is associated with a poor prognosis in CRC patients. The novel glycolysis-related prognostic risk model formulated in this study offers significant potential for enhancing the diagnosis and treatment of CRC.
Humans ; Colorectal Neoplasms/pathology* ; Glycolysis/genetics* ; Prognosis ; Transcriptome ; Tumor Microenvironment/genetics* ; Gene Expression Profiling ; Single-Cell Analysis ; Gene Expression Regulation, Neoplastic ; Male ; Female ; Kaplan-Meier Estimate

Objective:To investigate the association between social jetlag and depressive symptoms among college students, as well as its potential influencing factors.Methods:A cross-sectional study was conducted through an online questionnaire platform (Wenjuanxing) from March to April 2023, collecting data on social jetlag, depressive symptoms, and other factors from students at Shantou University. Social jetlag time was defined as the absolute difference between the midpoint of sleep time on weekends and weekdays, with a cutoff at the 75th percentile. The presence of social jetlag was defined as social jetlag time≥1 hour. Depressive symptoms were assessed using the Beck Depression Inventory (BDI), with a score of≥10 indicating the presence of depressive symptoms. Participants were divided into depressive symptom group (BDI≥10) and non-depressive symptom group (BDI<10). Linear regression and logistic regression models were used to analyze the relationship between social jetlag and depressive symptoms, with interaction terms and subgroup analyses to explore potential influencing factors.Results:A total of 1 323 college students were included. The social jetlag time (median 0.71 hour vs. 0.50 hour, Z=-3.36, P<0.001) and prevalence of social jetlag (37.64% vs. 30.57%, χ2=7.03, P=0.008) were both higher in the depressive symptom group than in the non-depressive symptom group. The linear regression model showed that each additional hour of social jetlag was associated with an increase of 0.67 points in BDI score (95% CI=0.16-1.18, β=0.06, P=0.010), after adjusting for age, gender, body mass index, being a medical student, smoking, drinking, caffeine intake, physical exercise, anxiety symptoms, insomnia symptoms, and sleep duration. The logistic regression model indicated that social jetlag was a risk factor for depressive symptoms (O R=1.34, 95% CI=1.02-1.76, P=0.036), which was moderated by physical exercise (interaction P=0.033). Among participants without physical exercise, social jetlag was associated with depressive symptoms ( OR=1.71, 95% CI=1.18-2.48, P=0.005), while no such association was found among those with physical exercise ( OR=0.97, 95% CI=0.64-1.47, P=0.892). Conclusion:Social jetlag may be associated with depressive symptoms in college students. This adverse relationship may be improved by enhancing physical exercise.

Objective:To analyze the relevant factors affecting treatment compliance in infertile patients with mycoplasma infection, construct a nomogram prediction model and validate it.Methods:In this case-control study, we retrospectively analyzed the clinical data of 400 infertile patients who attended the Department of Reproduction of Ganzhou Maternal and Child Health Hospital, Jiangxi Province from April 2022 to March 2024. They were divided into modeling group ( n=280) and validation group ( n=120) according to the 7∶3 principle with random number method, and further divided into complete compliance subgroup and unstable compliance subgroup based on different levels of compliance. Multiple logistic regression model was used to analyze the risk factors affecting treatment adherence in infertile patients with mycoplasma infection, variance inflation factor was used to assess the collinearity of the independent variables and to construct a columnar plot prediction model, and the validation and predictive efficacy of the columnar plot model were assessed by calibration curves and decision curves, respectively. The validation and predictive efficacy of the column chart model were evaluated by calibration curve and decision curve respectively. Results:In the modeling group, there was no significant statistical difference between the fully compliant group and the unstable compliant group in terms of body mass index, place of residence, occupation, settlement form, and attitude of medical staff (all P>0.05). Age in the unstable adherence subgroup [(33.22±3.20) years], proportion of junior high school and below in education [36.81% (67/182)], proportion of average monthly disposable amount ≤2 000 yuan [36.81% (67/182)], proportion of poor disease awareness [62.09% (113/182)], and infertility related stress scale (IRSS) scores (45.60±17.14) were higher than those in the full adherence subgroup [(31.36±3.24) years, P<0.001; 19.39% (19/98), P=0.003; 16.33% (16/98), P<0.001; 28.57% (28/98), P<0.001; 37.64±16.69, P<0.001]. The receiver operating characteristc curve analysis results showed that the optimal cutoff values for age and IRSS score were 32 years old and 42 points, respectively. The results of logistic multiple regression model showed that: age ( OR=1.453, 95% CI: 1.260-1.794, P=0.002), education level ( OR=1.386, 95% CI: 1.185-1.564, P<0.001), average monthly disposable amount ( OR=1.081, 95% CI: 1.002-1.246, P=0.023), disease awareness level ( OR=1.827, 95% CI: 1.390-2.359, P<0.001), and average monthly disposable amount ( OR=1.081, 95% CI: 1.002-1.246, P=0.023), disease awareness ( OR=1.827, 95% CI:1.390-2.359, P<0.001), and IRSS score ( OR=1.590, 95% CI: 1.255-1.902, P=0.006) were independent risk factors affecting treatment adherence in infertile patients with mycoplasma infection. The modeling group C-index was 0.872 (0.816-0.927), the intercept (-0.004) and slope (0.995) of the calibration curve were close to the desirable values of 0 and 1, the Brier score was 0.017, and thresholds between 0.37 and 0.96 provided a net clinical benefit. The C-index of the test model set was 0.816 (0.736-0.896), the intercept (-0.007) and slope (1.015) of the calibration curve were close to the ideal values of 0 and 1, the Brier score was 0.013, and the threshold value provided a net clinical benefit when the threshold value ranged from 0.21 to 0.98, and the H-L goodness-of-fit test showed that χ 2=7.36, P=0.499, and the constructed predictive model for the column line graphs had good discrimination and consistency. Conclusion:Age, educational level, monthly average disposable income, disease awareness, and IRSS score are the relevant factors affecting treatment compliance in infertile patients with mycoplasma infection. The nomogram prediction model constructed in this study based on those relevant factors has a good predictive value for treatment compliance in infertile patients with mycoplasma infection, and can provide certain reference for clinical intervention measures.

Objective:To analyze the relevant factors affecting treatment compliance in infertile patients with mycoplasma infection, construct a nomogram prediction model and validate it.Methods:In this case-control study, we retrospectively analyzed the clinical data of 400 infertile patients who attended the Department of Reproduction of Ganzhou Maternal and Child Health Hospital, Jiangxi Province from April 2022 to March 2024. They were divided into modeling group ( n=280) and validation group ( n=120) according to the 7∶3 principle with random number method, and further divided into complete compliance subgroup and unstable compliance subgroup based on different levels of compliance. Multiple logistic regression model was used to analyze the risk factors affecting treatment adherence in infertile patients with mycoplasma infection, variance inflation factor was used to assess the collinearity of the independent variables and to construct a columnar plot prediction model, and the validation and predictive efficacy of the columnar plot model were assessed by calibration curves and decision curves, respectively. The validation and predictive efficacy of the column chart model were evaluated by calibration curve and decision curve respectively. Results:In the modeling group, there was no significant statistical difference between the fully compliant group and the unstable compliant group in terms of body mass index, place of residence, occupation, settlement form, and attitude of medical staff (all P>0.05). Age in the unstable adherence subgroup [(33.22±3.20) years], proportion of junior high school and below in education [36.81% (67/182)], proportion of average monthly disposable amount ≤2 000 yuan [36.81% (67/182)], proportion of poor disease awareness [62.09% (113/182)], and infertility related stress scale (IRSS) scores (45.60±17.14) were higher than those in the full adherence subgroup [(31.36±3.24) years, P<0.001; 19.39% (19/98), P=0.003; 16.33% (16/98), P<0.001; 28.57% (28/98), P<0.001; 37.64±16.69, P<0.001]. The receiver operating characteristc curve analysis results showed that the optimal cutoff values for age and IRSS score were 32 years old and 42 points, respectively. The results of logistic multiple regression model showed that: age ( OR=1.453, 95% CI: 1.260-1.794, P=0.002), education level ( OR=1.386, 95% CI: 1.185-1.564, P<0.001), average monthly disposable amount ( OR=1.081, 95% CI: 1.002-1.246, P=0.023), disease awareness level ( OR=1.827, 95% CI: 1.390-2.359, P<0.001), and average monthly disposable amount ( OR=1.081, 95% CI: 1.002-1.246, P=0.023), disease awareness ( OR=1.827, 95% CI:1.390-2.359, P<0.001), and IRSS score ( OR=1.590, 95% CI: 1.255-1.902, P=0.006) were independent risk factors affecting treatment adherence in infertile patients with mycoplasma infection. The modeling group C-index was 0.872 (0.816-0.927), the intercept (-0.004) and slope (0.995) of the calibration curve were close to the desirable values of 0 and 1, the Brier score was 0.017, and thresholds between 0.37 and 0.96 provided a net clinical benefit. The C-index of the test model set was 0.816 (0.736-0.896), the intercept (-0.007) and slope (1.015) of the calibration curve were close to the ideal values of 0 and 1, the Brier score was 0.013, and the threshold value provided a net clinical benefit when the threshold value ranged from 0.21 to 0.98, and the H-L goodness-of-fit test showed that χ 2=7.36, P=0.499, and the constructed predictive model for the column line graphs had good discrimination and consistency. Conclusion:Age, educational level, monthly average disposable income, disease awareness, and IRSS score are the relevant factors affecting treatment compliance in infertile patients with mycoplasma infection. The nomogram prediction model constructed in this study based on those relevant factors has a good predictive value for treatment compliance in infertile patients with mycoplasma infection, and can provide certain reference for clinical intervention measures.

Objective:To investigate the application value of photon-counting detector CT (PCD-CT) in preoperative identification of critical anatomical structures and surgical assessment in pancreatic cancer, and to compare its performance with conventional energy-integrating detector CT (EID-CT) in delineating tumor margins, vascular structures, and neural anatomy.Methods:This single-center retrospective matched case-control study included 25 patients with pathologically confirmed pancreatic ductal adenocarcinoma who underwent PCD-CT enhanced scanning and curative surgery at Peking Union Medical College Hospital between February and June 2025 (PCD-CT group). These patients were matched in a 1∶2 ratio to 50 patients who underwent EID-CT between January 2016 and December 2024 and subsequently received curative surgery (EID-CT group). Tumor boundary clarity, vascular visualization scores, and neural structure visibility were subjectively evaluated using the Likert scoring system. The assessed vessels included the celiac artery, common hepatic artery, superior mesenteric artery, splenic artery, portal vein, superior mesenteric vein, splenic vein, and pancreaticoduodenal arterial arcade. Imaging-based assessment of structural involvement was compared with intraoperative findings and pathological results to calculate diagnostic accuracy. Surgeons rated the usefulness of PCD-CT images for identifying key structures and determining resectability using a 5-point Likert scale. The Mann-Whitney U test was used for group comparisons of subjective scores, and categorical data were analyzed using the χ2 test or Fisher exact test. Results:The PCD-CT group showed significantly higher scores for tumor boundary clarity, vascular visualization, and neural structure detectability than those of the EID-CT group (all P<0.05). The accuracy of assessing superior mesenteric vein involvement was 96.0% (24/25) in the PCD-CT group and 72.0% (36/50) in the EID-CT group, with a significant difference ( χ2=6.00, P=0.014). Postoperative surgeon evaluations indicated that PCD-CT provided substantial assistance for both key structure identification [5 (5, 5)] and resectability assessment [5 (4, 5)]. Conclusion:PCD-CT demonstrates superior performance over EID-CT in preoperative delineation of tumor margins, vascular structures, and neural anatomy and in the assessment of structural involvement in pancreatic cancer. It provides valuable anatomical information to support preoperative evaluation and surgical decision-making.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To investigate the association between social jetlag and depressive symptoms among college students, as well as its potential influencing factors.Methods:A cross-sectional study was conducted through an online questionnaire platform (Wenjuanxing) from March to April 2023, collecting data on social jetlag, depressive symptoms, and other factors from students at Shantou University. Social jetlag time was defined as the absolute difference between the midpoint of sleep time on weekends and weekdays, with a cutoff at the 75th percentile. The presence of social jetlag was defined as social jetlag time≥1 hour. Depressive symptoms were assessed using the Beck Depression Inventory (BDI), with a score of≥10 indicating the presence of depressive symptoms. Participants were divided into depressive symptom group (BDI≥10) and non-depressive symptom group (BDI<10). Linear regression and logistic regression models were used to analyze the relationship between social jetlag and depressive symptoms, with interaction terms and subgroup analyses to explore potential influencing factors.Results:A total of 1 323 college students were included. The social jetlag time (median 0.71 hour vs. 0.50 hour, Z=-3.36, P<0.001) and prevalence of social jetlag (37.64% vs. 30.57%, χ2=7.03, P=0.008) were both higher in the depressive symptom group than in the non-depressive symptom group. The linear regression model showed that each additional hour of social jetlag was associated with an increase of 0.67 points in BDI score (95% CI=0.16-1.18, β=0.06, P=0.010), after adjusting for age, gender, body mass index, being a medical student, smoking, drinking, caffeine intake, physical exercise, anxiety symptoms, insomnia symptoms, and sleep duration. The logistic regression model indicated that social jetlag was a risk factor for depressive symptoms (O R=1.34, 95% CI=1.02-1.76, P=0.036), which was moderated by physical exercise (interaction P=0.033). Among participants without physical exercise, social jetlag was associated with depressive symptoms ( OR=1.71, 95% CI=1.18-2.48, P=0.005), while no such association was found among those with physical exercise ( OR=0.97, 95% CI=0.64-1.47, P=0.892). Conclusion:Social jetlag may be associated with depressive symptoms in college students. This adverse relationship may be improved by enhancing physical exercise.